The pursuit of beauty: what compels women to go under the knife?

We have been modifying our faces for centuries, discovers Louisa Peacock,
who interviews leading plastic surgeon Dr Bryan Mendelson on what compels
women to go under the knife, the pursuit of beauty and why some surgery
looks really, really bad.

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Then and now: Women in Paris were having 'lunchtime facelifts' in the 1920s, a trend which has continued ever since, says Dr Bryan Mendelson.Photo: Getty

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Dr Bryan Mendelson: Most of my patients don't tell their husbands about their facial surgery

The overwhelming majority of Dr Bryan Mendelson's patients hide the fact they are having plastic surgery on their face from their husbands and/ or children, he tells me casually. Most women decide to go under the knife without consulting their nearest and dearest, he says.

When I ask him to put a figure on it, he says assertively that "99.99pc" of his patients don't tell their other halves. But why? We live in a society obsessed with looks and yet the very women who are worried about their own appearance shield the lengths they're prepared to go to change the way they look.

Are women ashamed of getting plastic surgery? Are they afraid of the reaction they might get? Do they think their husbands will try and talk them out of it?

"People have surgery not to impress others, they do it to impress themselves," Dr Mendelson says in defence of his patients. "For many people, it's about getting their confidence back.

"99.99pc of my patients hide eye lid surgery, chin tucks and other facial operations from their husbands and kids. Patients' husbands tend to freak out about surgery, saying 'I love her the way she is, why would she risk doing that?'," he says, adding the women tell their loved ones they're going on holiday with their friends, when actually they're staying at his clinic for a few weeks. Some wait until he goes away on a business trip. "The fact is it's about self-esteem. They're doing it for themselves."

Dr Mendelson is a world-renowned plastic surgeon with 25 years' experience in the field of facial surgery. A past president of the International Society of Aesthetic Plastic Surgery, he's pretty much seen and done it all when it comes to cosmetic surgery. We meet because he has a new book out, In Your Face, detailing real-life stories of why women (and some men) go under the knife. But I can't buy his reasoning. If the husband loves his wife the way she is, then why oh why is she getting plastic surgery? Is she mad?

Golden moment: Mark (Colin Firth) tells Bridget he likes her just the way she is

The amount of single women I know who are dying to find a bloke that loves her just the way she is, heck,there have been films about it,songs about it– to many women this is the ideal man. I can't help but wonder what's led these women to actively ignore their men who love them, just the way they are, and favour the knife instead.

Shouldn't we be learning to love our inner selves, not give in to the endless pressure from Hollywood films, TV adverts and gossip magazines that feed off airbrushed looks and size zero models?

Dr Mendelson nods his head in agreement. "In an ideal world, sure, but that doesn't happen," he says. "People aren't doing surgery to win someone's hand in marriage, they're doing it for their inner self. There comes a time, in your 40s and 50s, when someone tells you you're looking tired. You were feeling OK until someone said that. But now when you look in the mirror you no longer see your vibrant self."

Of course, he would say that. He is in the business of cosmetic surgery. He is clearly keen to promote his new book.

But he insists that the public's perception ofplastic surgeryis entirely different to the everyday people and stories he comes across. "The way themedia portrays cosmetic surgery,it sensationalises people who look ridiculous after an operation. Those with big, fat lips or breasts that are way too big for them. But the vast majority of people who undergo surgery have something subtle done. They don't want to tell people as they don't want to be treated differently. It's like make-up, they don't want people to notice what they've had done. They're doing it purely for themselves and their own self-esteem." They say beauty is in the eye of the beholder, but I suppose that doesn't matter if you feel rubbish about yourself deep down.

Still, self-esteem comes from inside: not the way you look. Isn't his line of work part of the problem?

"Superficially, yes," he says. "But you're talking about people who aren't happy with themselves. If people aren't happy they're not going to make themselves happy by going through surgery. I do tell people this and have turned some, generally those with a psychological adjustment, away."

Former Tory MP Louise Mensch revealed she has had cosmetic surgery, claiming it was maintenance as she likes her appearance.

Dr Mendelson says he only operates on those women who are "mature" enough to know what they're doing and handle the consequences in the rare event something should go wrong. His youngest patients have been 16 year-old girls who want a nose job, but more common are middle-aged women asking for surgery to improve the bags under their eyes or "droopy" jaw lines, he says. Again, he explains most women see surgery as a way of improving their self esteem.

If he can't convince me, he suspects it's because I'm not his "target audience". We joke I should come back to him in 10 years' time – when I will inevitably have that "shocking mirror" moment. I refrain from telling him that I do, regularly, have those mirror moments. I do fret about how I look. But I feel confident enough in myself that I will never go under the knife to fix it.

Plastic surgery on the rise

Perhaps I am in the minority. The latest statistics from the British Association of Aesthetic Plastic Surgeons show demand for anti-ageing procedures soared in the past year – even despite the recession.

Its figures show facial rejuvenation treatments, in particular, eyelid surgery, fat transfer, brow and face lifts, all experienced a double-digit rise. Face and brow lifts were up 14pc and 17pc respectively, while eyelid surgery and fat transfer were both up 13pc.

Some 43,172 surgical procedures were carried out by BAAPS members in 2012, a 0.2pc increase from 2011, when 43,069 were performed. Of those, 39,070 were women, up from 38,771 the previous year.

Overall, boob jobs were still the most popular procedure, with around 10,000 breast augmentations last year.

Yet interestingly, women had more fat-injecting than fat-removing procedures for the first time, with 2,641 fat transfer procedures compared with 2,638 liposuction ops.

Men are getting in on the act too – male brow lifts went up by 19pc to 149, the figures show. It's still a tiny proportion, but interestingly, men account for roughly one in 10 of all cosmetic surgery patients.

In his book, Dr Mendelson hopes to change the common "misconceptions" around going under the knife by showing us it is becoming more "normal" and is done for perfectly valid reasons. He takes us through the "fascinating history" of facial surgery, showing us that it is no new phenomenon for people to want to change the way they look. We humans have been modifying our faces for centuries, he says.

Changing faces – over centuries

He takes us back in time and revisits the birth of reconstructive surgery. One chapter is dedicated to Gaspare Tagliacozzi (1545 – 1599), the "founding father of plastic surgery, even though he lived well before it was known by that name".

The book reads:

He was a professor of anatomy and surgery at the University of Bologna, where he developed a new skin flap technique for the nose, and, significantly, wrote about it, in the first textbook of plastic surgery, De curtorum chirurgia per insitionem, ('The surgery of defects by implantations'), in 1597. This detailed, illustrated work is akin to some of today's surgical atlases, and even to this day plastic surgeons make 'pilgrimages' to Bologna to stand in front of Tagliacozzi's statue in the city's anatomy theatre, where he is posed holding a nose in his hand.

In his book, Tagliacozzi outlined step by step the exact procedure for 'restoration of deformed noses, ears and lips by skin grafting; and of the instruments and bandages used in this surgical engrafting'.

Illustration from Tagliacozzi's book, De curtorum chirurgia, showing his famous harness devised to keep stable contact between the upper arm and the nose for the period of 'implantation', up to 21 days.

In more modern times, Dr Mendelson looks at the lunchtime face lifts of 1920s France and explains his own research which has helped to change the face of aesthetic plastic surgery.

1920s France: A patient of Dr Suzanne Noel (1878 – 1954), who operated on her patients in her own apartment in Paris, combs her hair after facial surgery to cover the stitches.

The book goes to great lengths to tell us how plastic surgery has evolved, mixed with anecdotal stories from his male and female patients about why they had it done.

Still, he admits the UK will likely never follow America, where it is more common for citizens to have aesthetic surgery. But times are changing, he says. "When your mother was growing up, it was true that you wouldn't risk having an anaesthetic unless you needed it. Also, you wouldn't risk going on an aeroplane flight, but nowadays you don't think twice about it. The world has changed a lot.

"Anaesthesia is just extraordinary these days, the control the anaesthetist has and the monitors, they can see ahead of time the oxygen levels going down or up, or blood pressure."

He also insists that facial procedures that are really bad – another burning issue of mine; that you can often tell when someone's had plastic surgery to the face – just aren't done well. "The truth is that kind of look is not really plastic surgery at all – it's cosmetic surgery by underqualified practitioners using outdated techniques," he says.

Cosmetic vs. medical surgery

We talk about the advancement in surgical procedures nowadays, and it isn't long before we get onto the subject of Angelina Jolie, (pictured above) whorevealed last week she had a double mastectomy to prevent breast cancer.Of course,Jolie's reasons for surgery were purely health-related, not cosmetic, which I suggest to Dr Mendelson is why so many people supported her decision. Had she have had cosmetic breast surgery, it probably would not have been received in the UK with such applause and amazement. "She's done a wonderful service for raising awareness about breast cancer," he says. "The fact she went public with it, most people wouldn't have done."

He continues: "She's such an icon, she's not going to feel the same about her breasts as she used to; it's not like she just takes the old ones out and puts new ones in, she's going to have scars there, and not normal feeling, but as long as she's alive for her children."

Surgery of all types – medical and cosmetic – is more common nowadays, but Dr Mendelson stresses he would never "trivialise it". He condemns TV makeover shows, which treat people like "products" for the sake of "entertainment" and could end up encouraging surgery for the wrong reasons. "I'm talking about doing it as an intrinsic part of who you really are," he says.

At the same time, he believes health-scares such as thePIP breast implant scandal, which has affected thousands of women, could put people off doing any type of cosmetic surgery – even relatively straightforward facial procedures.

We talk about implants to the face, to rebuild cheeks, and the thought of anybody messing with my face in that way makes me shiver. It dawns on me that I'm probably one of Dr Mendelson's hardest critics; previous, medical operations I've had in the past, including major back surgery, make it hard for me to perceive myself ever having cosmetic surgery.

I understand his argument that the face is a key communications tool – essential and immediate. Humans need their faces to make contact, to make themselves understood. I can even see why, as a society, we're so invested in appearance – and how 'beautiful people' can often be treated better, even if we don't like to admit it. But the lengths some people will go to to change the way they look? And worse still, hide it from their husbands? It still boggles me.